Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Increased Epicardial and Thoracic Pre-Aortic Fat Depots Predict Vulnerable Coronary Plaque in Asymptomatic Patients with Rheumatoid Arthritis (RA).

Karpouzas1,  George A., Ahmadi2,  Naser, Hajsadeghi2,  Fereshteh, Choi2,  Tae-Young, Munoz2,  Silvia, Budoff2,  Mathew

Harbor-UCLA, Long Beach, CA
Harbor-UCLA

Background:

There is increasing evidence of an association between volume of visceral adipose tissue (VAT) and clinical or subclinical atherosclerosis. Perivascular AT including epicardial (EAT), pericardial (PAT), thoracic pre-aortic (TAT) and subcutaneous (SAT) is metabolically active and a source of pro-inflammatory as well as anti-inflammatory cytokines with both paracrine and systemic effects. VAT volume and associations with coronary plaque burden and features in RA are unknown. We assessed the volume of these AT depots in asymptomatic patients (pts) with RA compared to non-RA matched controls for age, gender and all traditional risk factors undergoing evaluation for coronary artery disease. Additionally, we explored the ability of these diverse AT depots to predict non-calcified (NC), lipid-rich, "vulnerable" coronary plaque burden in RA.

Methods:

We report on 74 recruited RA pts from a single center. Pts underwent VAT evaluation with 64+ slice multidetector Computed Tomography Angiography (MDCTA), with advantages of submillimeter collimation, high temporal and spatial resolution, and 3-dimensional views of the heart and its epicardial surface. Additionally, MDCTA detects coronary plaque with equal accuracy to conventional angiography, and is superior in assessing "vulnerable" plaque. Coronary trees were graded in a standard fashion according to Americn Heart Association (AHA). Non-parametric tests were used for data analysis; linear regressions between different AT depot volumes and vulnerable plaque, as well as relative risk regression models for AT volume risk and prediction of vulnerable plaque burden in RA pts were constructed after adjustments for age, sex, classic coronary risk (CRF), RA duration, and disease activity.

Results:

Patients with RA had significantly higher volumes of EAT, PAT, TAT and SAT compared to non-RA matched controls (p<0.05 for all, table 1). RA subjects had 44% higher EAT and 49% higher TAT volume risk than non-RA controls after adjustments for age, sex, all CRF, and body mass Index (p=0.001 and 0.005 respectively). Additionally, RA pts had significantly higher total coronary plaque burden (p=0.01), predominantly accounted for by "vulnerable" NC plaque (p=0.0001). EAT and TAT where the strongest predictors of "vulnerable" plaque (p=0.001 for both) in asymptomatic RA pts. EAT volume change was the strongest predictor of presence and extent of such friable, high-risk coronary plaque after adjustments for age, sex, all CRF, body mass Index, DAS28-3v and disease duration (p=0.009), followed by TAT (p=0.01).

Conclusions:

VAT tissue depots- especially EAT and TAT- are significantly expanded in asymptomatic RA pts compared to matched controls. They significantly predict the presence of "vulnerable" coronary plaque and remain its strongest determinants after adjustments for traditional CRF, anthropometric, and RA-specific features.

Table 1. Patient Characteristics

VariableRA (74)Controls (74)p
EAT (cc)109.9 ± 46.589.2 ± 38.50.001
PAT (cc)47.9 ± 32.441.1 ± 29.50.04
TAT (cc)157.9 ± 67.8130.3 ± 56.10.01
SAT (cc)53.9 ± 2445.3 ± 29.50.04
Relative Risk Regressions*   
EAT (cc)1.44 (1.09–1.96)1.0 (Ref)0.001
PAT (cc)1.31 (1.07–2.15)1.0 (Ref)0.008
TAT (cc)1.49 (1.11–2.03)1.0 (Ref)0.005
SC (cc)1.22 (1.03–2.21)1.0 (Ref)0.03
Total plaque burden score6.4 ± 4.84.3 ± 4.10.01
  Non-calcified3.2 ± 4.31 ± 2.90.0001
  Mixed1.7 ± 2.90.9 ± 20.01
  Calcified1.5 ± 3.42.4 ± 3.30.19
RA cohort (n = 74) Linear Regressionsr (NC plaque burden)r2b (95% CI)p
EAT0.420.181.72 (1.11–2.48)0.001
PAT0.270.081.41 (1.09–3.51)0.03
TAT0.460.212.18 (1.34–8.56)0.001
SAT0.190.041.25 (1.03–5.54)0.03
RA cohort (n = 74)** Relative Risk RegressionsNC/Mixed Plaque Score 0NC/Mixed Plaque Score >0p
EAT (cc)1.0 (Ref)2.68 (1.35–3.24)0.009
PAT (cc)1.0 (Ref)1.54 (1.09–1.91)0.01
TAT (cc)1.0 (Ref)2.36 (1.19–2.56)0.01
SC (cc)1.0 (Ref)1.29 (1.01–1.93)0.04
* Adjusted for age, gender, all conventional risk factors, and BMI.
** Adjusted for age, gender, all CRF, BMI, DAS28-3v and RF duration.

To cite this abstract, please use the following information:
Karpouzas, George A., Ahmadi, Naser, Hajsadeghi, Fereshteh, Choi, Tae-Young, Munoz, Silvia, Budoff, Mathew; Increased Epicardial and Thoracic Pre-Aortic Fat Depots Predict Vulnerable Coronary Plaque in Asymptomatic Patients with Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2166
DOI: 10.1002/art.29930

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